• Xiangyu Wang, Ning Tu, Feng Sun, Zhi Wen, Xinxin Lan, Yi Lei, Enming Cui, and Fan Lin.
• Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China.
• J Magn Reson Imaging. 2021 Oct 1; 54 (4): 1212-1221.

BackgroundAccurate evaluation of the invasion depth of tumors with a Vesical Imaging-Reporting and Data System (VI-RADS) score of 3 is difficult.PurposeTo evaluate the diagnostic performance of a new magnetic resonance imaging (MRI) strategy based on the integration of the VI-RADS and tumor contact length (TCL) for the diagnosis of muscle-invasive bladder cancer (MIBC).Study TypeSingle center, retrospective.SubjectsA group of 179 patients with a mean age of 67 years (range, 24.0-96.0) underwent multiparametric MRI (mpMRI) before surgery, including 147 (82.1%) males and 32 (17.9%) females. Twenty-four (13.4%), 90 (50.3%), 43 (24.0%), 15 (8.4%), and 7 (3.9%) cases were Ta, T1, T2, T3, and T4, respectively.Field Strength/SequenceA 1.5 T and 3.0 T, T2-weighted turbo spin-echo (TSE), single-shot echo-planar (SS-EPI), diffusion-weighted imaging (DWI), and T1-weighted volumetric interpolated breath-hold examination (T1-VIBE).AssessmentThree radiologists independently graded the VI-RADS score and measured the TCL on index lesion images. A proposed MRI strategy called VI-RADS_TCL was introduced by modifying the VI-RADS score, which was downgraded to VI-RADS 3F (equal to a VI-RADS score of 2) if VI-RADS = 3 and TCL < 3 cm.Statistical TestsIntraclass correlation coefficients (ICCs), Mann-Whitney U test, chi-square tests, receiver operating characteristic (ROC) curves, and 2 × 2 contingency tables were applied.ResultsInter-reader agreement values were 0.941 (95% CI, 0.924-0.955) and 0.934 (95% CI, 0.916-0.948) for the TCL and VI-RADS score. The TCL was significantly increased in the MIBC group (6.40-6.85 cm) compared with the NMIBC group (1.98-2.45 cm) (P < 0.05). The specificity and positive predictive values (PPV) of VI-RADS_TCL were 82.46%-87.72% and 90.91%-91.59%, which were significantly greater than VI-RADS score (P < 0.05). Additionally, 52.17%-55.88% NMIBC lesions with VI-RADS 3 were downgraded to 3F by using VI-RADS_TCL.Data ConclusionThe proposed MRI strategy could reduce the false-positive rate of lesions with a VI-RADS score of 3 while retaining sensitivity.Evidence Level4 TECHNICAL EFFICACY: 2.© 2021 International Society for Magnetic Resonance in Medicine.

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